Madrigal Pharmaceuticals, the first company to get U.S. approval for a medicine treating the common liver disease MASH, is now exploring new ways to tackle the condition using RNA therapies. The company has teamed up with Suzhou Ribo Life Science from China, licensing six experimental RNA programs. Madrigal will pay $60 million initially and up to $4.4 billion more if certain goals are met. RNA interference therapies could potentially turn off genes that produce proteins linked to MASH, or metabolic dysfunction-associated steatohepatitis. Madrigal plans to test this approach alongside their approved drug, Rezdiffra, hoping to find an even more effective treatment. Madrigal’s quick success with Rezdiffra surprised many. Despite years of failed attempts by other drugmakers, Madrigal proved that a MASH drug could be successful. Some analysts were unsure if there would be a large market for a MASH drug, as the disease often goes unnoticed and some symptoms can be managed with diet and exercise. However, Rezdiffra’s sales have consistently exceeded expectations. Since its launch, awareness of MASH has increased, leading to a significant rise in diagnoses. Now, Madrigal faces competition. Novo Nordisk’s weight loss drug, Wegovy, has been approved to treat MASH, and other treatments are in advanced stages of testing. Despite this, Madrigal is working to maintain its leading position. In addition to the recent deal, the company has licensed experimental drugs from Pfizer and another Chinese company, CSPC Pharmaceutical Group. Madrigal now has over 10 programs targeting different aspects of the disease. Analysts see this latest deal as a strategic move that diversifies Madrigal’s approach and is commercially attractive. It supports Madrigal’s efforts to build on Rezdiffra’s success as a leading therapy for MASH.